PDF(Pubmed)
Abstract：
Lymphadenectomy represents a fundamental step in the staging and treatment of non-small cell lung cancer (NSCLC). To date, the extension of lymphadenectomy in early-stage NSCLC is a debated topic due to its possible complications. The detection of sentinel lymph nodes (SLNs) is a strategy that can improve the selection of patients in which a more extended lymphadenectomy is necessary. This pilot study aimed to refine lymph nodal staging in early-stage NSCLC patients who underwent robotic lung resection through the application of innovative intraoperative sentinel lymph node (SLN) identification and the pathological evaluation using one-step nucleic acid amplification (OSNA). Clinical N0 NSCLC patients planning to undergo robotic lung resection were selected. The day before surgery, all patients underwent radionuclide computed tomography (CT)-guided marking of the primary lung lesion and subsequently Single Photon Emission Computed Tomography (SPECT) to identify tracer migration and, consequently, the area with higher radioactivity. On the day of surgery, the lymph nodal radioactivity was detected intraoperatively using a gamma camera. SLN was defined as the lymph node with the highest numerical value of radioactivity. The OSNA amplification, detecting the mRNA of CK19, was used for the detection of nodal metastases in the lymph nodes, including SLN. From March to July 2021, a total of 8 patients (3 female; 5 male), with a mean age of 66 years (range 48-77), were enrolled in the study. No complications relating to the CT-guided marking or preoperative SPECT were found. An average of 5.3 lymph nodal stations were examined (range 2-8). N2 positivity was found in 3 out of 8 patients (37.5%). Consequently, pathological examination of lymph nodes with OSNA resulted in three upstages from the clinical IB stage to pathological IIIA stage. Moreover, in 1 patient (18%) with nodal upstaging, a positive node was intraoperatively identified as SLN. Comparing this protocol to the usual practice, no difference was found in terms of the operating time, conversion rate, and complication rate. Our preliminary experience suggests that sentinel lymph node detection, in association with the accurate pathological staging of cN0 patients achieved using OSNA, is safe and effective in the identification of metastasis, which is usually undetected by standard diagnostic methods.
摘要：
淋巴结切除术是分期和治疗非小细胞肺癌（NSCLC）的基本步骤。迄今为止,早期非小细胞肺癌的淋巴结清扫术因其可能的并发症而扩大是一个有争议的话题.前哨淋巴结（SLN）的检测是一种策略，可以改善需要进行更广泛的淋巴结清扫术的患者的选择。这项初步研究旨在通过应用创新的术中前哨淋巴结（SLN）鉴定和使用一步核酸扩增（OSNA）的病理评估，来完善接受机器人肺切除术的早期NSCLC患者的淋巴结分期。选择计划进行机器人肺切除术的临床N0NSCLC患者。手术前一天,所有患者均接受放射性核素计算机断层扫描（CT）引导的原发性肺部病变标记，随后进行单光子发射计算机断层扫描（SPECT）以识别示踪剂迁移和，因此,放射性较高的区域。手术那天,术中使用伽马相机检测淋巴结放射性。SLN被定义为具有最高放射性数值的淋巴结。OSNA扩增，检测CK19的mRNA，用于淋巴结转移的检测，包括SLN。从2021年3月至7月，共有8名患者（3名女性；5名男性），平均年龄66岁（48-77岁），参加了这项研究。未发现与CT引导标记或术前SPECT相关的并发症。平均检查了5.3个淋巴结站（范围2-8）。在8例患者中有3例(37.5%)发现N2阳性。因此,用OSNA对淋巴结进行病理检查导致从临床IB期到病理IIIA期的三个升级阶段。此外，在1例(18%)淋巴结升级的患者中，术中发现一个阳性节点为SLN.将此协议与通常的做法进行比较，在运行时间方面没有发现差异，转化率，和并发症发生率。我们的初步经验表明前哨淋巴结检测，与使用OSNA获得的cN0患者的准确病理分期相关，在识别转移方面是安全有效的，通常无法通过标准诊断方法检测到。
